Evaluation OfAnalgesic Effect of Femoral Nerve Block for Positioning Of Patient For Subarachnoid Block In Patients With Fracture Femur: A Randomized, Double Blind, Parallel Group, Comparative Study Between Ropivacaine And Bupivacaine
FNB for positioning for subarachnoid block in femur fracture
Keywords:
Analgesia, Bupivacaine, Femoral nerve block, Femur fracture, RopivacaineAbstract
Background: Ropivacaine is recently introduced in Indian market, need to evaluate further for its clinical profile. We evaluated the analgesic effect of Ropivacaine in comparision with Bupivacaine in femoral nerve block (FNB) for positioning of patient for subarachnoid block in patients with fracture femur. Method: Hundred patients of either sex, aged 18-80 years, American Society of Anaesthesiologist physical status I–III having femur fracture scheduled for surgery under subarachnoid block. The patients were randomly allocated into two groups of 50 patients each. Group R received Ropivacaine and Group B received Bupivacaine (20 ml, 0.5 %) in FNB guided by peripheral nerve locator. Patients were observed for onset and peak effect of sensory and analgesia, hemodynamic profile and complications if any. Results: The mean time for onset of sensory block and analgesia were comparable in both the groups (p>0.05). The peak of sensory block and subjective analgesia achieved earlier in group R (p<0.001), but objective analgesia score was comparable in both the groups (p > 0.05). Haemodynamics remain stable and no complications were noted except vascular puncture.
Conclusion: We conclude that FNB provides effective analgesia in patients with fracture femur for positioning of patient before subarachnoid block. We recommend the use of Ropivacaine as safer alternative to Bupivacaine in femoral nerve block, especially in compromised cardiovascular patients.
[ Vaghela K NJIRM 2014; 5(4) :61-66]
References
2. McGlone R. Femoral nerve block in the initial management of femoral shaft fractures. Archives of Emergency Medicine 1987; 4(3):163-168.
3. Salvatore Sia MD, Francesco Pelusio MD, Remo Barbagli, MD and Calogero Rivituso, MD.A Comparison Between Femoral Nerve Block and Intravenous Fentanyl: Anesthesia& Analgesia. October 2000; 99(4): 1221-1224.
4. Jeng C. L., Torrillo T. M. Complications of peripheral nerve blocks. BJA 2010; 105(1): 97- 107.
5. Scott DB, Lee A, Fagan D, Bowler GM, Bloomfield P, Lundh R. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesthesia& Analgesia.1989 Nov; 69(5):563-9.
6. Knudsen K, Beckman Suurküla M, Blomberg S, Sjövall J, Edvardsson N. Central nervous and cardiovascular effects of iv infusions of ropivacaine, bupivacaine. Br J Anaesth. 1997 May; 78(5):507-14.
7. Weiss RJ, Montgomery SM, Al Dabbagh Z, Jansson KA. Complications and injuries associated with midshaft femur fractures in the adult can be life-threatening. National data of 6409 Swedish 2009; 40:304.
8. Hedlund R, Lindgren U. Epidemiology of diaphyseal femoral fracture. ActaOrthopScand 1986; 57:423.
9. Moore KL, Dalley AF. Clinically Oriented Anatomy. 5th ed.Philadelphia, PA: Lippincott Williams & Wilkins; 2006:566.
10. Schiferer A, Gore C, Gorove L, Lang T, Steinlechner B, Zimpfer M, Kober A.A randomized controlled trial of femoral nerve blockade administered preclinically for pain relief in femoral trauma. Anaesthesia & Analgesia 2007 Dec;105(6):1852-4.
11. Markham A, Faulds D. Ropivacaine: a review of its pharmacology and therapeutic use. Regional anaesthesia drugs1996; 52:429–49.
12. Hartrick CT. Trauma. In: Raj PP, editor. Textbook of Regional Anesthesia.New York: Churchill Livingstone. 2002:897.
13. ArissaraIamaroon.Femoral nerve block versus iv fentanyl for analgesiafor positioning patients with fractured femur. dove press journal 2010, 20 march;3:21-26.
14. Nerve Stimulator (Reproduced from Clinical Anesthesia: 6th edition, Paul G. Barash, Bruce Cullen, Robert K. Stoelting).
15. R Mageswaran, Y C Choy. Comparison of 0.5% Ropivacaine and 0.5% Levobupivacaine for Infraclavicular Brachial Plexus Block. Med J Malaysia 2010 Dec; 65(4):302-304.
16. William L. Young, Jeanine P. Weinner- Kronish and Lee A Fleisher. Miller’s Anaesthesia 5th edition;1:46-49.
17. Bertini L, Tagariello V, Mancini S, Ciaschi A, Posteraro CM, Di Benedetto P, Martini O. 0.75% and 0.5% ropivacaine for axillary brachial plexus block: a clinical comparison with 0.5% bupivacaine. Regional Anesthesia Pain Med. 1999, Nov-Dec; 24(6):514-8.
18. BariÅŸkaner H, Tuncer S, Ulusoy H, Dogan N. Effects of bupivacaine and ropivacaine on hemodynamic parameters in rabbits. Methods find Exp Clinical Pharmacology. 2001 March;23(2):89-92.
